‘Ultimately, the answer to the social care crisis lies in structural change driven by the central government.’
Photograph: Dean Mitchell/Getty Images

When parliament does one day agree on reforms to the system of adult social care in England, there should be a moment of mourning for those who did not live to see the day. For decades this subject has been a focus of independent commissions, parliamentary inquiries, thinktank pamphlets and, last year, a citizens’ assembly – with each report striking a more urgent tone than the last. Yet the present government still has not published its own social care proposals.

A green paper was promised last March. The charity Age UK estimates that 54,000 people have died waiting for a care package since then. It is a macabre metric but the point is no less true for being uncomfortable: failure of political courage on this issue is deadly.

Distraction by Brexit partly accounts for the delay. But not long ago, in May 2017, Theresa May thought there would be time, alongside European negotiations, to change the way asset wealth was taken into account when calculating entitlement to cost-free social care. The policy and the election manifesto in which it appeared never recovered from hostile branding as the “dementia tax”.

That fiasco better explains Mrs May’s failure to grapple with hard questions at the heart of the social care challenge: who pays and how? Labour encountered the same obstacle in the final days of Gordon Brown’s government, with a plan that eyed deceased persons’ estates as a source of finance for a national care service. The Tories lambasted the proposal as a “death tax”.

It shames British political culture that the two main English parties could come so close to consensus on such a contentious subject, each grasping the need for higher contributions from those most able to pay for their care, and still allow aggressive partisanship to thwart progress.

The immediate political burden of that failure has been felt by local government, with councils struggling even to meet their statutory social care obligations, let alone satisfy public demand for a wider range of services. A report by the Commons public accounts committee (PAC) this week warned that ministers are in “denial” about the state of local authority finances and described as “disturbing” the government’s failure to make sustainable plans for the long term. A boost of £1.4bn in last autumn’s budget was a short-term fix that cannot revitalise a system depleted by a decade of austerity. This week, parliament approved an annual settlement that was advertised, improbably, by the communities secretary, James Brokenshire, as a step towards “reinvigorated” local government. The PAC notes that English authorities have lost around half of their funding since 2010, while demand for care services has increased.

Ultimately, the answer to the social care crisis lies in structural change driven by the central government. The parameters of such a reform have been examined often enough. There is no great mystery. Social care provision must be better integrated with the NHS. New revenue streams will be needed. That could mean compulsory insurance, hypothecated levies, perhaps applied only over a certain age, combined with some way to recoup care costs from estates. Inevitably, opposition politicians will be tempted to denounce such a measure as a wicked tax on ageing or death – and fear of that charge will deter governments from acting. Neither side dares to confront voters with realistic choices. That cycle of timidity must be broken. It is wasting precious time and costing lives.